This aim of this application is to help the candidate achieve the broad career goal of becoming an independent clinical investigator with primary emphasis on ethnic group disparities in health care services for rheumatic disease. Building on the candidate's research and clinical experience as a clinical psychologist, the proposed training plan in (a) basic and clinical science of rheumatic disease, (b) ethnic disparities in health care services, (c) health communication, (d) clinical trial design and evaluation, and (e) healthcare economics will produce a skilled researcher able to address biopscyhosocial issues in her research area. The research plan includes 4 studies of ethnic disparities in patient preferences for total joint replacement (T JR) for knee osteoarthritis (OA). These studies test several hypotheses derived from prospect theory concerning effects of message framing on patients' T JR outcome expectations and willingness to undergo T JR, if recommended by their physician. Study 1 examines ethnic group differences in outcome expectations and willingness to undergo T JR in a population-based sample of persons with knee or hip OA. Next, two pilot studies will be performed to aid the development and initial evaluation of a prospect theory-based, educational intervention that includes gain- or loss-framed messages regarding T JR outcomes. Study 4 tests effects of the video-based intervention on patients with knee OA from UAB Rheumatology Clinic. Patients will report their outcome expectations and willingness to undergo T JR, prior to and after the intervention. For Studies 1 and 4, it is hypothesized that African-Americans, compared to Caucasians, will report significantly more negative outcome expectations and less willingness to undergo T JR; the group difference in T JR preferences will be mediated by outcome expectations. For Study 4, it is hypothesized that loss-framed messages, relative to gain-framed messages, will evoke significantly more positive changes in T JR outcome expectations and willingness to undergo T JR among patients with initial negative oucome expectations.